We recently completed the BMI2 study, which tested the efficacy of two increasingly intensive interventions among overweight/obese youth ages 2-8 recruited from 39 practices in the American Academy of Pediatrics PROS network (Pediatric Research in Office Settings). Group 1 (Usual Care) was compared with treatment Groups 2 and 3 on BMI percentile at 2-year follow up. Group 2 comprised trained primary care practitioners (PCPs) who delivered 4 motivational interviewing (MI) sessions and Group 3, in addition to the 4 PCP MI sessions, had 6 MI sessions delivered by trained Registered Dietitians (RDs) linked with each practice. At two- year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for Usual Care, PCP only, and PCP + RD groups, respectively. The PCP + RD group mean was significantly lower than the UC group. A next logical step in our research is to test the populatio effect of the BMI intervention among all patients, when the intervention is delivered under more real world conditions. The proposed study will test the effectiveness of an enhanced version of the BMI2 intervention disseminated through 18 PROS practices (not participating in the BMI2 study). The primary aim will be to determine the impact of the intervention (change in BMI percentile) on the entire population of overweight and obese youth ages 3-10 in these 18 sites, based on shared Electronic Health Record data. We will pair-match and randomize all clinics to the either Usual Care or BMI2. For clinics assigned to BMI2, all PCPs will be trained in MI and the BMI2 intervention. To bring the intervention to scale, some key changes will be made to the intervention. First, despite the promising effects of BMI2, only 27% (37/141) of Group 3 participants were exposed to >=75% of the planned MI dose. This was due primarily to low completion of the RD counseling, only 2.7 out of 6 sessions were delivered. We will increase dose in several ways. First, we will add two-way tailored text messaging. Parents will receive 1-2 SMS per week, tailored to their family behaviors. In addition they will receive reminders for upcoming MI calls and reminders to schedule their child's assessments. We will implement the RD counseling through a centralized disease management system at our Center for Health Communications (CHCR). By centralizing the RD counseling at the U of M, we will be able to substantially increase the dose and quality of the RD intervention, and therefore increase intervention impact. Reach will be maximized by using trained office managers to approach all eligible families (child >85th percentile). The primary outcome is change in BMI z-score at two year followup. Secondary Hypothesis will explore BMI change among the subsample of youth exposed to the intervention. Exploratory Aims include quantifying revenue generated from obesity-related counseling at these clinics and compare revenue between the BMI2 and usual care clinics. The RE-AIM framework will guide analysis of reach, dissemination, and implementation in both the intervention and UC groups.